AccountId: 011433970860
ContactId: 1bd8adfa-8db3-40cc-80c9-6b26d29b7eff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215740 ms
Total Talk Time (AGENT): 89961 ms
Total Talk Time (CUSTOMER): 92478 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/1bd8adfa-8db3-40cc-80c9-6b26d29b7eff_20250313T18:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]. I am calling from Bel Air Surgery Center and I have a patient who's coming in for an outpatient surgery, um, and I need to see um what her benefits are for this plan.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Alright, so she gave me two different ones, so I'm not sure which one is the ID number. Um, I have a 025791.
[CUSTOMER][NEUTRAL] 29 M for Mary, L for Lima, and the number 8.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. You're calling in regards to outpatient benefits.
[CUSTOMER][NEUTRAL] Yes, it's gonna be done um outpatient ambulatory surgery.
[AGENT][NEUTRAL] OK, I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome, and verification of coverage does not guarantee the payment of the claim for outpatient, the member has up to $200 per calendar day that will go towards the primary insurance deductible, co-insurance, or co-pay. This policy is for sickness and injury only. It will not cover any preventative or wellness. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] All right. So she's got $200 a day that they would cover, but it's not for, so like if she's coming in, let's say it's a hemorrhoid energy therapy, they're gonna cover $200 of it or that's not gonna get covered?
[AGENT][NEUTRAL] As long as the procedure is for sickness and injury, then it's considered open the outpatient benefit. If it's for preventative wellness, it's not.
[CUSTOMER][NEUTRAL] OK, so it's not sickness.
[CUSTOMER][NEUTRAL] OK, so then they're not gonna cover anything cause it's not sickness or injury.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] It's an elective procedure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that would not be considered sickness surgery. I don't believe, but I mean, I guess we could put it in and run it and if they're gonna cover, they're gonna cover, if not.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Who, what is the claims mailing address?
[AGENT][POSITIVE] Yes, let me get that for you.
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] You also have the option to submit it in via fax or the secured portal and we will need the primary EOB and that claim for that date of service.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, um, alright, I think that's all I need. Can I have a reference number?
[AGENT][NEUTRAL] Yes, the reference number will be my first name, [PII], last initial of H and today's date.
[CUSTOMER][POSITIVE] Thank you for your help I appreciate it.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you.